Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T23:43:46.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Surgical Site Infection in a Community Hospital Network

Published online by Cambridge University Press:  11 February 2016

Arthur W. Baker ,
Kristen V. Dicks ,
Michael J. Durkin ,
David J. Weber ,
Sarah S. Lewis ,
Rebekah W. Moehring ,
Luke F. Chen ,
Daniel J. Sexton  and
Deverick J. Anderson
Arthur W. Baker*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
Kristen V. Dicks
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
Michael J. Durkin
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
Sarah S. Lewis
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
*
Address correspondence to Arthur W. Baker, MD, MPH, Duke University Medical Center, Box 102359, Room 181 Hanes House, Durham, NC 27710 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To describe the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens

METHODS

We prospectively collected SSI data at 29 community hospitals in the southeastern United States from 2008 through 2012. We determined the overall prevalence rates of SSI for commonly performed procedures during this 5-year study period. For each year of the study, we then calculated prevalence rates of SSI stratified by causative organism. We created log-binomial regression models to analyze trends of SSI prevalence over time for all pathogens combined and specifically for MRSA.

RESULTS

A total of 3,988 complex SSIs occurred following 532,694 procedures (prevalence rate, 0.7 infections per 100 procedures). SSIs occurred most frequently after small bowel surgery, peripheral vascular bypass surgery, and colon surgery. Staphylococcus aureus was the most common pathogen. The prevalence rate of SSI decreased from 0.76 infections per 100 procedures in 2008 to 0.69 infections per 100 procedures in 2012 (prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82–1.00). A more substantial decrease in MRSA SSI (PRR, 0.69; 95% CI, 0.54–0.89) was largely responsible for this overall trend.

CONCLUSIONS

The prevalence of MRSA SSI decreased from 2008 to 2012 in our network of community hospitals. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence over the study period.

Infect Control Hosp Epidemiol 2016;37:519–526

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 519 - 526
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: An abstract containing preliminary data was presented at IDWeek 2014, October 10, 2014, Philadelphia, Pennsylvania.

References

REFERENCES

1. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32:970–986.CrossRefGoogle ScholarPubMed
2. Healthcare-associated Infections. Centers for Disease Control and Prevention (CDC) website. http://www.cdc.gov/HAI/surveillance. Published 2014. Accessed December 12, 2014.Google Scholar
3. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.CrossRefGoogle ScholarPubMed
4. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports 2007;122:160–166.CrossRefGoogle ScholarPubMed
5. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278; quiz 279–280.CrossRefGoogle ScholarPubMed
6. Anderson, DJ, Pyatt, DG, Weber, DJ, Rutala, WA, North Carolina Department of Public Health HAIAG. Statewide costs of health care-associated infections: estimates for acute care hospitals in North Carolina. Am J Infect Control 2013;41:764–768.Google Scholar
7. Scott, RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention (CDC) website. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published 2009. Accessed March 1, 2015.Google Scholar
8. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
9. Anderson, DJ, Kaye, KS, Chen, LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PloS One 2009;4:e8305.Google Scholar
10. Lewis, SS, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:1229–1230.Google Scholar
11. Anderson, DJ, Sexton, DJ, Kanafani, ZA, Auten, G, Kaye, KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28:1047–1053.CrossRefGoogle ScholarPubMed
12. National and State Healthcare Associated Infections. Progress Report. Centers for Disease Control and Prevention (CDC) website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Published 2014. Accessed December 11, 2014.Google Scholar
13. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Internal Med 2013;173:1970–1978.Google Scholar
14. David, MZ, Daum, RS, Bayer, AS, et al. Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008–2011: significant geographic variation in community-onset infections. Clin Infect Dis 2014;59:798–807.CrossRefGoogle ScholarPubMed
15. Landrum, ML, Neumann, C, Cook, C, et al. Epidemiology of Staphylococcus aureus blood and skin and soft tissue infections in the US military health system, 2005–2010. JAMA 2012;308:50–59.CrossRefGoogle ScholarPubMed
16. Boston, KM, Baraniuk, S, O’Heron, S, Murray, KO. Risk factors for spinal surgical site infection, Houston, Texas. Infect Control Hosp Epidemiol 2009;30:884–889.Google Scholar
17. Trinh, JV, Chen, LF, Sexton, DJ, Anderson, DJ. Risk factors for Gram-negative bacterial surgical site infection: do allergies to antibiotics increase risk? Infect Control Hosp Epidemiol 2009;30:440–446.Google Scholar
18. Friedman, ND, Sexton, DJ, Connelly, SM, Kaye, KS. Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol 2007;28:1060–1065.CrossRefGoogle ScholarPubMed
19. Chattopadhyay, R, Zaroukian, S, Potvin, E. Surgical site infection rates at the Pontiac Health Care Centre, a rural community hospital. Can J Rural Med 2006;11:41–48.Google ScholarPubMed
20. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315–322.Google Scholar
21. Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27:228–232.CrossRefGoogle ScholarPubMed
22. Procedure Associated Module: Surgical Site Infection (SSI) Event. Centers for Disease Control and Prevention (CDC) website. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Published 2015. Accessed January 15, 2015.Google Scholar
23. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S–157S.Google Scholar
24. Kaye, KS, Sloane, R, Sexton, DJ, Schmader, KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006;54:391–396.Google Scholar
25. Dicks, KV, Lewis, SS, Durkin, MJ, et al. Surveying the surveillance: surgical site infections excluded by the January 2013 updated surveillance definitions. Infect Control Hosp Epidemiol 2014;35:570–573.CrossRefGoogle ScholarPubMed
26. Ming, DY, Chen, LF, Miller, BA, Anderson, DJ. The impact of depth of infection and postdischarge surveillance on rate of surgical-site infections in a network of community hospitals. Infect Control Hosp Epidemiol 2012;33:276–282.Google Scholar
27. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
28. Wurtz, R, Wittrock, B, Lavin, MA, Zawacki, A. Do new surgeons have higher surgical-site infection rates? Infect Control Hosp Epidemiol 2001;22:375–377.Google Scholar
29. Kaafarani, HM, Kaufman, D, Reda, D, Itani, KM. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res 2010;163:229–234.CrossRefGoogle ScholarPubMed
30. Greenland, S, Pearl, J, Robins, JM. Causal diagrams for epidemiologic research. Epidemiology 1999;10:37–48.Google Scholar
31. Weng, HY, Hsueh, YH, Messam, LL, Hertz-Picciotto, I. Methods of covariate selection: directed acyclic graphs and the change-in-estimate procedure. Am J Epidemiol 2009;169:1182–1190.Google Scholar
32. Anderson, DJ, Hartwig, MG, Pappas, T, et al. Surgical volume and the risk of surgical site infection in community hospitals: size matters. Annals Surg 2008;247:343–349.Google Scholar
33. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. New Engl J Med 2010;362:18–26.CrossRefGoogle ScholarPubMed
34. Lee, I, Agarwal, RK, Lee, BY, Fishman, NO, Umscheid, CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010;31:1219–1229.Google Scholar
35. Noorani, A, Rabey, N, Walsh, SR, Davies, RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Brit J Surg 2010;97:1614–1620.Google Scholar
36. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. AJHP 2013;70:195–283.Google Scholar
37. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. New Engl J Med 2013;368:2255–2265.Google Scholar
38. Viray, MA, Morley, JC, Coopersmith, CM, Kollef, MH, Fraser, VJ, Warren, DK. Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection. Infect Control Hosp Epidemiol 2014;35:243–250.Google Scholar
39. Moore, CL, Hingwe, A, Donabedian, SM, et al. Comparative evaluation of epidemiology and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) USA300 infections causing community- and healthcare-associated infections. Int J Antimicrob Agents 2009;34:148–155.Google Scholar
40. Jenkins, TC, McCollister, BD, Sharma, R, et al. Epidemiology of healthcare-associated bloodstream infection caused by USA300 strains of methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Infect Control Hosp Epidemiol 2009;30:233–241.Google Scholar